Critical care medicine
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Critical care medicine · Oct 2002
Prognostic significance of admission cardiac troponin T in patients treated successfully with direct percutaneous interventions for acute ST-segment elevation myocardial infarction.
Cardiac troponin T (cTnT) elevations at admission indicate a high-risk subgroup of patients with acute ST-segment elevation myocardial infarction, possibly due to a higher failure rate of reperfusion therapies. ⋯ Admission cTnT is a strong predictor of future cardiac risk in patients with ST-segment elevation myocardial infarction, despite successful restoration of Thrombolysis in Myocardial Infarction grade 3 coronary flow by direct percutaneous coronary intervention.
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To investigate the effectiveness of capnometry (carbon dioxide monitoring) in verifying gastric placement of a stylet-guided nasogastric tube in intubated, mechanically ventilated patients. ⋯ Capnometry is a safe method for verifying proper feeding tube placement. The first chest roentgeno-gram can be safely eliminated. With this method, less time and money will be expended in feeding tube placement, making capnometry an efficacious new method.
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Critical care medicine · Oct 2002
Elimination kinetics of myoglobin and creatine kinase in rhabdomyolysis: implications for follow-up.
Creatine kinase and myoglobin are markers of muscular damage in rhabdomyolysis. Whereas myoglobin is considered to be the principal compound causing tubular damage, serum creatine kinase level is presently guiding therapeutic interventions in clinical practice to prevent acute renal failure. Because differences in elimination kinetics of these two compounds may influence therapeutic decisions, we studied elimination kinetics of myoglobin and creatine kinase in patients with rhabdomyolysis. ⋯ Serum myoglobin has faster elimination kinetics than creatine kinase in patients treated with forced alkaline diuresis for rhabdomyolysis. Considering the etiologic role of myoglobin, our data suggest that serum myoglobin level, rather than that of creatine kinase, should be used to guide therapy in patients with rhabdomyolysis.
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Critical care medicine · Oct 2002
Prognosis of hematologic malignancies does not predict intensive care unit mortality.
To evaluate the correlation between specific prognosis of hematologic malignancies on the one hand and intensive care unit and hospital mortality in critically ill patients with hematologic malignancies on the other hand. ⋯ Prognosis of hematologic malignancies does not predict intensive care unit or hospital mortality and almost reaches significance for 6-mo mortality (53%, 71%, and 84% rate for patients with good, intermediate, and poor prognosis, respectively, p =.058), but it determines long-term survival (p =.008). Intensive care unit, hospital, and 6-mo overall mortality rates were 38%, 61%, and 75%, respectively. Using multivariate analysis, intensive care unit mortality was best predicted on admission by respiratory failure and fungal infection, whereas hospital mortality was predicted by the number of organ failures, the bone marrow transplant status, and the presence of fungal infection. The Acute Physiology and Chronic Health Evaluation II and the Simplified Acute Physiology Score II had no prognostic value, whereas the difference of the Multiple Organ Dysfunction Score between at the time of admission and at day 5 allowed quick prediction of hospital mortality. Diseases with the poorest 6-mo prognosis were acute myeloid leukemia and non-Hodgkin lymphoma. CONCLUSION The severity of the underlying hematologic malignancies does not influence intensive care unit or hospital mortality. Short-term prognosis is exclusively predicted by acute organ dysfunctions and by a pathogen's aggressiveness. Therefore, reluctance to admit patients with nonterminal hematologic malignancies to the intensive care unit based only on the prognosis of their underlying hematologic malignancy does not seem justified.
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Critical care medicine · Oct 2002
Case ReportsFloating aortic thrombus in systemic aspergillosis and detection by transesophageal echocardiography.
After immunosuppressive treatment for a colitis ulcerosa, a 49-yr-old man developed signs of systemic aspergillosis with subsequent septic shock and encephalitis. For recurrent signs of thromboembolism, transesophageal echocardiography was performed and revealed a large floating thrombus of the aortic arch. ⋯ The present case is the first report of in vivo detection of large vessel involvement in systemic aspergillosis by transesophageal echocardiography. In our opinion, transesophageal echocardiography is the method of choice for bedside diagnosis of this rare complication in critically ill patients.